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Original Article
 
Pancreaticogastrostomy ... Seven years tertiary hospital experience
Deena Hadedeya, MD1, Hanaa Al-Hashemy, MD1, Saud Al-Muhammadi, MD, FRCS1
1Department of Surgery, King Faisal Specialist Hospital & Research Center ((Gen. Org.), Jeddah, Kingdom of Saudi Arabia.

Article ID: 100049IJHPDDH2016
doi: 10.5348/ijhpd-2016-49-OA-5

Address correspondence to:
Deena Saleh Hdedeya
General Surgery Resident-R5
Department of surgery, King Faisal Specialist Hospital & Research Center (Gen. Org.)-Jeddah
Kingdom of Saudi Arabia

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How to cite this article
Hadedeya D, Al-Hashemy H, Al-Muhammadi S. Pancreaticogastrostomy ... Seven years tertiary hospital experience. Int J Hepatobiliary Pancreat Dis 2016;3:18–25.


Abstract
Aims: Pancreaticoduodenectomy (PD) is the treatment of choice for periampullary tumors. However, this procedure carries significant risk and potential morbidity, mostly related to pancreatic anastomotic failure. Many techniques have been described in an attempt to decrease the anastomotic leak rate and related complications. Pancreaticogastrostomy (PG) is one of the techniques utilized to restore pancreatic continuity after pancreatic head resection. The aim of this study is to share our experience with the pancreaticogastrostomy technique.
Methods: Retrospective review of all those patients who underwent pancreaticoduodenectomy between 2008 to August 2015 at King Faisal Specialist Hospital and Research Center (Gen. Org.), Jeddah, Kingdom of Saudi Arabia. A total of 36 patients underwent a pancreaticoduodenectomy with a pancreaticogastrostomy using our modified technique. Variables studied included indications for surgery, intraoperative and postoperative factors and postoperative complications.
Results: At King Faisal Specialist Hospital and Research Center (Gen. Org.), Jeddah in group of patients who underwent pancreaticogastrostomy (n=36) including 21 males and 15 females, the mean age was 58.44 years (SD 15.76). Total 62% of patients had BMI ≥ 25 (7 are missing). Intraoperatively, the pancreatic stump was soft and friable in 31.6% of the cases. The histopathology review postoperatively showed seven benign cases and 29 malignant cases. The indications for pancreaticoduodenectomy based on the histopathology have been divided into seven main categories: adenocarcinomas, neuroendocrine tumors, intraductal tumors, pseudopapillary tumors, cystic lesions of the pancreas, trauma and others including inflammations and fibrosis. The mean tumor size was 3.29 cm in diameter (range, 0–11 cm) with (0–6) number of lymph node involvement. The mean tumor size for malignant lesions was 3.57 cm in diameter while in benign lesions the mean tumor size was 2.66 cm in diameter. There was a vascular invasion in 23.5% of the cases. Fibrosis presented in 41.7% of the specimens. The highest morbidity in our series following pancreaticoduodenectomy was, wound infection 22.2%, atelectasis 13.9%, delayed gastric emptying and postoperative bleeding 8.3%. Others include Intraoperative and postoperative hemorrhage, abscesses and collections, wound dehiscence and pulmonary embolism (PE) counted for 5.6% of the complications. Intraoperative bleeding, pancreatic fistula, biliary fistulas, lymphatic duct injury and deep venous thrombosis (DVT) occurred in 2.8% of the patients.
Conclusion: Pancreatic stump invagination into the gastric lumen with a two layers fixation of the ventral surface of the pancreas might be associated with a lower risk of pancreatic anastomosis failure compared with other techniques. Further prospective validation with a larger number of cases is needed to support our results.

Keywords: Anastomotic leak, Pancreatic fistula, Pancreaticogastrostomy, Pancreaticojujenostomy, Periambullary tumors, Whipple procedure


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Author Contributions:
Deena Hadedeya – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hanaa Al-Hashemy – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Saud Al-Muhammadi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Deena Hadedeya et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.